Prescription: Palliative Care: Morphine Syringe Drive

Casebank Prescription
1

Where you are
You are FY2 in hospice care home

Who the patient is
Mrs. Maria Smith, aged 80, is diagnosed with metastatic pancreatic cancer

Other information
Patient is terminal palliative care has been prescribed. She has been referred from hospital to hospice
for the continuation of palliative care. She cannot eat or drink.

Special Note
None

What you must do
Write down the prescription of her palliative caste medications

Hospital Handover Note:
Patient name: Maria Smith Date of Birth: 25/03/1942 NHS Number:123456 Hospital No: 1234
Allergy: Penicillin Reaction-n: Breathlessness

Dear Doctor,
Mrs. Maria Smith, aged 80, has been admitted in the Hospice Care Home with pancreatic cancer. She is
terminally ill and cannot eat or drink.

Plan: She will be discharged to hospice for palliative care with the following medications:

  • Morphine 30mg/24h SC via syringe driver
  • Morphine for breakthrough pain SC
  • Cyclizine 50mg TDS SC (maximum 150mg) for nausea and vomiting.
  • Hyoscine bromide 400 micrograms SC 4 hourly (maximum 2.4mg) for secretion.
  • Paracetamol 1g PO every 4 to 6 hours (maximum 4 g/day) for pain.
  • Atorvastatin 10mg PO OD

Shortcut:

  1. Syringe Drive Chart: Morphine 30mg in 24 hours SC
    Diluent: water for injection
  2. Only PRN: Morphine 5mg SC 4 hourly (max 30mg), Cyclizine, Hyoscine
  3. Stop oral drugs: Paracetamol & Atorvastatin

Explanation:
Two morphine here. One for breakthrough pain and another via syringe driver. Write accordingly.

  1. Morphine for breakthrough pain:
    Its 1/6 th of total dose of morphine. If total dose is less than 30 then its 30/6 means 5mg. so dose 5mg,
    frequency 4 hourly and max dose: 30mg.
  2. Morphine via syringe driver:
    Now a days they are providing you extra syringe driver sheet. If you get this in your exam, write on that sheet. If not, then in regular section.
4 Likes